PNS

Question 1

High Radial nerve palsy usually caused by

Answer 1

direct pressure of the nerve as a result of

 1. humeral fracture 
 2. elbow dislocation 
3. prolonged compression “Saturday night palsy”

Question 2

High Radial palsy Symptoms are

Answer 2

1. unable to extend Wrist MCP joints
   2 extend or radial abduct thumb
2. decreased sensation dorsum forearm + hand (wristdrop deformity )

Question 3

Would a person with high radial palsy be able to extend elbow?

Answer 3

usually because triceps are usually spared
(supinator + brachioradialis are paralyzed) Elbow flexion and supination are possible because musculocutaneous nerve innervate the bicep

Question 4

Would a person with high radial palsy be able to flex the elbow? Supinate?

Answer 4

yes both are possible because musculocutaneous nerve innervates the bicep.
(supinator + brachioradialis are paralyzed)

Question 5

What are nerve injuries that cause motor impairments?

Answer 5

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Question 6

What are nerve injuries that cause sensory impairments?

Answer 6

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Question 7

Posterior Interosseous Nerve Syndrome is an injury to what nerve?

Answer 7

to radial nerve around the arcade of

Frohse/supinator causing motor problems in wrist and hand

Question 8

Posterior Interosseous Nerve Syndrome is caused by?

Answer 8

1. entrapment of nerve in supinator muscle 2. elbow dislocation
2. Poor technique during ORIF of proximal radius FX if hardware pinches nerve 4.compression of radial nerve from

Question 9

Posterior Interosseous Nerve Syndrome Symptoms

Answer 9

unable to extend
MCP joints
extend or radial abduct thumb
able to extend wrist but is radial deviated

Question 10

Is Posterior Interosseous Nerve Syndrome motor or sensory

Answer 10

purely motor pain may be present but it is not primary symptom no sensory

Question 11

Radial Tunnel Syndrome causes

Answer 11

compression/irritation of radial nerve proximal forearm at edge of supinator causing pain in the anterolateral proximal forearm

1. inflammation from repetitive forceful supination pronation of forearm and wrist flexion extension   2. direct blow to the area

Question 12

Radial Tunnel Syndrome Symptoms

Answer 12

Tenderness achiness and pain on the outside of the elbow about 2 inches distal to the lateral epicondyle.

Question 13

Radial Tunnel Syndrome what increases pain

Answer 13

1. wrist extension
2. active supination
3. pronation
4. holding something with the staight elbow

Question 14

Does Radial Tunnel Syndrome cause muscle weakness

Answer 14

Primarily pain syndrome can cause weakness in wrist extensors making it difficult to steady wrist during grasping and lifting.

Question 15

Does Radial Tunnel Syndrome cause sensory changes

Answer 15

No sensory changes usually because sensory portion of radio nerve branches off the elbow often misdiagnosed for lateral epicondylitis

Question 16

How may radial tunnel syndrome and lateral epicondyleitis be clinically distinguished from each other?

Answer 16

pain from radial tunnel syndrome is usually more PROXIMAL FOREARM area about four fingerbreadths distal lateral condyle

pain from lateral epicondyleitis tends to originate where the TENDON that attaches to the lateral epicondyle

Question 17

Why is it important to know the difference between radial tunnel syndrome and lateral epicondyleitis thinking treatment stratagies?

Answer 17

Common treatment for lateral epicondyleitisis use of elbow strap worn snugly around the proximal for use of the strap will make radial tunnel syndrome symptoms worse by further compressing the radial nerve

Question 18

What is appropriate body mechanics training for radial tunnel syndrome

Answer 18

temporarily avoid task requiring

1. pronation supination
2. reaching with arms extended at shoulder 3. level overhead work with wrist flexed forearms pronated

Question 19

Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome)

strengthing as tolerated

Answer 19

1. close direct trauma or prolonged pressure to rest area 3-4 cm proximal to wrist
2. surgical pinning for distal radius fx 3. tumor/mass
3. repetitive ulnar deviation and pronation causing pressure between ECRL and brachioradialis tendons

Question 20

Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome) Symptoms are

Answer 20

decreased sensation and/or tingling in the distribution of the radial sensory nerve dorsum of hand radial side

Question 21

Superficial Radial Nerve Syndrome is often made worse by

Answer 21

extreme pronation, wrist movement, tight pinching of thumb and index can be uncomfortable at radial aspect of wrist burning pain

Question 22

Superficial Radial Nerve Syndrome is often misdiagnosed for

Answer 22

DeQuervain’s tenosynovitis because of location of pain

Question 23

How is superficial radial nerve syndrome and DeQuervain’s differentiated?

Answer 23

• Superficial radial nerve syndrome generally have numbness and tingling over the back of the back of hand
• DeQuervain’s are not likely to have sensory issues.

Question 24

What splint is used Superficial Radial Nerve Syndrome? What do you need to watch for?

Answer 24

thumb spica an incorrectly applied splint will make symptoms of superficial radial nerve syndrome worse. watch tightness of stress and pressure from radial edge of wrist splint
OT intervention thumb

Question 25

Pronator Syndrome is (Rare) but what is the cause?

Answer 25

compression of the median nerve in proximal forearm causing pain and numbness in the thumb index long fingers (most common cause entrapment of the median nerve between the two heads of the pronator teres but there are three other sites a possible compression in this general area)

Question 26

Pronator Syndrome Symptoms

Answer 26

Tenderness over pronator teres muscle/volar forearm is aggravated by resisted pronation of forearm numbness tingling thumb, index, long, and half ring finger (volar palm) generally no motor involvement

Question 27

Pronator Syndrome causes impairment of which of the following pain motor sensory

Answer 27

pain | sensory (numbness)

Question 28

What is the Balentine sign?

Answer 28

attempts to perform tip Pinch (okay sign) thumb index the DIP joint collapse weakness paralysis of hhhh FPL and index FDP

Question 29

What is Anterior Interosseous Syndrome

Answer 29

rare entrapment of the motor branch of median nerve in proximal forearm

Question 30

What does Anterior Interosseous Syndrome cause

Answer 30

pain and weakness in the thumb index and long fingers

Question 31

What are the causes Anterior Interosseous Syndrome

Answer 31

1. Trauma to elbow forearm area fractured elbow dislocation direct blow causing either direct nerve trauma secondary trauma from hemorrhages 2. ORIF forearm fracture 3. Entrapment ORIF forearm fracture compression from fibrous bands in forearm

Question 32

Anterior Interosseous Syndrome Symptoms

Answer 32

- Deep aching pain in proximal forearm increases with activity, - weakness of FPL FDP 1+2 and pronator quadratus thus positive Balentine sign and - difficulty picking small items from flat surface usually no sensory problem

Question 33

Does Anterior Interosseous Syndrome impair sensory motor or pain

Answer 33

pain is most presenting some motor (weakness) usually no sensory problem

Question 34

Carpal tunnel syndrome basic description is

Answer 34

compression of the median nerve as it passes through the carpal tunnel associated

Question 35

Carpal tunnel Symptoms are

Answer 35

burning tingling numbness pain in palm of hand especially thumb index and long fingers Pain can also radiate proximately into the arm *** grip strength thenar muscles wasting in severe and untreated cases

Question 36

Is swelling visible in Carpal tunnel syndrome

Answer 36

no but a persons hand feel the sensation of swelling usually worse at night

Question 37

Laceration to median nerve are usually due to

Answer 37

due to knife or glass

Question 38

high-level Laceration to median nerve are usually lacerated at what site

Answer 38

elbow or proximal forearm leads to ape hand deformity

Question 39

high-level Laceration to median nerve symptoms

Answer 39

- loss of thener opposition and Palmer abduction - some IP flexion - thenar atrophy thumb lies to the side of palm - paralysis of FDS in the radail half of FDP with their corresponding to lumbricals causing loss of index finger MCP and PIP flexion -pronator teres is paralyzed so pronation is difficult sensory loss in hand median nerve distribution

Question 40

low-level lacerations to the median nerve are usually lacerated at what site

Answer 40

wrist area

Question 41

low-level lacerations to the median nerve symptoms

Answer 41

thenar eminence flattening loss of thumb opposition and Palmer of abduction due to paralysis of the median nerve innervated intrinsics sensory loss median nerve distribution of hand

Question 42

What is another name for Cubital Tunnel Syndrome? Give a brief description

Answer 42

“cell phone elbow” irritation of the ulnar nerve as it passes superficially of the elbow

Question 43

Cause of Cubital Tunnel Syndrome.

Answer 43

1. stretching nerve prolonged of the flexion | 2. pressure on nerves resting elbow on table desk armchair

Question 44

What are the Symptoms Cubital Tunnel Syndrome

Answer 44

- pain along the medial aspect of the elbow and tenderness over cubitul tunnel - Numbness tingling in ring and small fingers severe cases will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness was so positive Fromet’s sign positive Wartenburg sign

Question 45

In severe cases of Cubital Tunnel Syndrome what may happen

Answer 45

will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness

Question 46

What is Fromet’s sign

Answer 46

tests for the action of adductor pollicis, which is weak with an ulnar nerve palsy. A patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands. A normal individual will be able to maintain a hold on the object without difficulty. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect.